CT血管造影联合经颅多普勒超声对锁骨下动脉盗血综合征血流动力学的评价效果
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摘要
目的:探讨CT血管造影(CTA)与经颅多普勒超声(TCD)联合评价锁骨下动脉盗血综合征(SSS)血流动力学变化及诊断价值。方法:对65例临床拟诊为SSS的患者行CTA和TCD检查,CTA观察患者锁骨下动脉(SubA)、无名动脉狭窄程度,TCD判定盗血程度并测定双侧椎动脉收缩期峰值流速(Vp)。结果:CTA检查发现58例患者SubA或无名动脉狭窄,58例患者中,TCD检查显示无盗血2例,盗血56例,其中Ⅰ级盗血15例,Ⅱ级盗血27例,Ⅲ级盗血14例;CTA检查显示轻度狭窄14例,中度狭窄17例,重度狭窄16例,闭塞11例。TCD诊断盗血程度与CTA所示SubA或无名动脉狭窄程度呈正相关关系(r=0.701,P<0.001)。56例SSS患者椎动脉Vp随SubA或无名动脉狭窄程度不同而变化:重度狭窄及闭塞患者患侧椎动脉Vp较轻、中度狭窄患者明显减慢,而健侧椎动脉Vp较轻、中度狭窄患者明显增快(均P<0.05)。结论:CTA与TCD两者联合应用能较全面地评估SSS患者血流动力学变化,可为临床筛查、病情评估、早期干预提供客观依据。
Objective:To explore the clinical value of CT angiography(CTA) combined with transcranial Doppler ultrasound(TCD) in the diagnosis of subclavian artery steal blood syndrome(SSS).Methods:CTA and TCD examinations were performed on 65 patients who were clinically diagnosed as SSS.The degree of subclavian artery(SubA) and innominate artery stenosis was evaluated by CTA.The degree of stealing blood was evaluated by TCD and the peak velocity(Vp) of bilateral vertebral artery systolic was measured.Results:58 patients with SubA or innominate artery stenosis were found by the CTA examination,among which,2 cases were found no stealing blood by TCD.Of 56 patients with blood supply stealing,there were 15 cases of grade Ⅰ,27 cases of grade Ⅱ and 14 cases of grade Ⅲ.CTA showed mild stenosis in 14 cases,moderate stenosis in 17 cases,severe stenosis in 16 cases and occlusion in 11 cases.Degree of stealing blood assessed by TCD was positively correlated with the degree of SubA or innominate artery stenosis evaluated by CTA(r=0.701,P<0.001).Vertebral arterial Vp of affected side in patients with severe stenosis and occlusion was significantly slower than that in patients with mild or moderate stenosis,whereas uninjured side Vp was faster(P<0.05).Conclusion:The combination of CTA and TCD could comprehensively evaluate the hemodynamic changes of patients with SSS and provide basis for clinical screening,disease evaluation and early intervention.
Objective:To explore the clinical value of CT angiography(CTA) combined with transcranial Doppler ultrasound(TCD) in the diagnosis of subclavian artery steal blood syndrome(SSS).Methods:CTA and TCD examinations were performed on 65 patients who were clinically diagnosed as SSS.The degree of subclavian artery(SubA) and innominate artery stenosis was evaluated by CTA.The degree of stealing blood was evaluated by TCD and the peak velocity(Vp) of bilateral vertebral artery systolic was measured.Results:58 patients with SubA or innominate artery stenosis were found by the CTA examination,among which,2 cases were found no stealing blood by TCD.Of 56 patients with blood supply stealing,there were 15 cases of grade Ⅰ,27 cases of grade Ⅱ and 14 cases of grade Ⅲ.CTA showed mild stenosis in 14 cases,moderate stenosis in 17 cases,severe stenosis in 16 cases and occlusion in 11 cases.Degree of stealing blood assessed by TCD was positively correlated with the degree of SubA or innominate artery stenosis evaluated by CTA(r=0.701,P<0.001).Vertebral arterial Vp of affected side in patients with severe stenosis and occlusion was significantly slower than that in patients with mild or moderate stenosis,whereas uninjured side Vp was faster(P<0.05).Conclusion:The combination of CTA and TCD could comprehensively evaluate the hemodynamic changes of patients with SSS and provide basis for clinical screening,disease evaluation and early intervention.
引文
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[3] 刘涛,张卓,李永军,等.64排螺旋CT血管成像在诊断锁骨下动脉盗血综合征中的应用探讨[J].临床荟萃,2012,27(21):1884-1885.
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[8] NORTH AMERICAN SYMPTOMATIC CAROTID ENDARTERECTOMY TRIAL COLLABORATORS.Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis[J].The New England Journal of Medicine,1991,325(7):445-453.
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[11] RANDOUX B,MARRO B,KOSKAS F,et al.Roximal great vessels of aortic arch:comparison of three dimensional gadoliniunr enhanced MR an geography and digital subtraction an geography[J].Radiology,2003,229(3):697-702.
[12] SCHARDEY H M,MEYER G,RAU H G,et al.Subclavian carotid transposition:an analysis of a clinical series and a review of the literature[J].European Journal of Vascular and Endovascular Surgery,1996,12(4):431-436.
[13] KARGIOTIS O,SIAHOS S,SAFOURIS A,et al.Subclavian steal syndrome with or without arterial stenosis:a review[J].Journal of Neuroimaging,2016,26(5):473-480.
[14] 任华日.外周动脉血流动力学机制的多普勒超声研究[D].西安:第四军医大学,2014.
[15] FU X Y,ZHANG Z D,LIANG K,et al.Subclavian steal syndrome decreases neurogenesis in the cerebellar cortex and affects cognitive function in rabbits[J].Experimental & Therapeutic Medicine,2015,10(4):1455.
[2] 蔡武,龚建平,乔方,等.64层螺旋CT血管成像与数字减影血管造影在锁骨下动脉盗血综合征诊断中的价值[J].中华老年心脑血管病杂志,2013,8(15):825-827.
[3] 刘涛,张卓,李永军,等.64排螺旋CT血管成像在诊断锁骨下动脉盗血综合征中的应用探讨[J].临床荟萃,2012,27(21):1884-1885.
[4] 李国岩.多层螺旋CT血管成像对锁骨下动脉盗血综合征的诊断价值[J].实用医技杂志,2015,22(5):501-502.
[5] OSIRO S,ZURADA A,GIELECKI J,et al.A review of subclavian steal syndrome with clinical correlation[J].Medical Science Monitor,2012,18(5):57-63.
[6] RINGELSTEIN E B. A practical guide to transcranial Doppler sonography [M].New York:Alan R Liss Inc,1989:108-110.
[7] 高山,黄家星.经颅多普勒超声的诊断技术与临床应用[M].北京:中国协和医科大学出版社,2004:11.
[8] NORTH AMERICAN SYMPTOMATIC CAROTID ENDARTERECTOMY TRIAL COLLABORATORS.Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis[J].The New England Journal of Medicine,1991,325(7):445-453.
[9] 唐光健.现代全身 CT 诊断学[M].2版.北京:中国医药科技出版社,2007:797-798.
[10] 王天佑,吕可洁,吴兆荣,等.锁骨下动脉窃血综合征及其外科治疗[J].中国循环杂志,2010,10(13):145-147.
[11] RANDOUX B,MARRO B,KOSKAS F,et al.Roximal great vessels of aortic arch:comparison of three dimensional gadoliniunr enhanced MR an geography and digital subtraction an geography[J].Radiology,2003,229(3):697-702.
[12] SCHARDEY H M,MEYER G,RAU H G,et al.Subclavian carotid transposition:an analysis of a clinical series and a review of the literature[J].European Journal of Vascular and Endovascular Surgery,1996,12(4):431-436.
[13] KARGIOTIS O,SIAHOS S,SAFOURIS A,et al.Subclavian steal syndrome with or without arterial stenosis:a review[J].Journal of Neuroimaging,2016,26(5):473-480.
[14] 任华日.外周动脉血流动力学机制的多普勒超声研究[D].西安:第四军医大学,2014.
[15] FU X Y,ZHANG Z D,LIANG K,et al.Subclavian steal syndrome decreases neurogenesis in the cerebellar cortex and affects cognitive function in rabbits[J].Experimental & Therapeutic Medicine,2015,10(4):1455.